Healthcare Provider Details

I. General information

NPI: 1124395629
Provider Name (Legal Business Name): UNIVERSITY OF CALIFORNIA SAN FRANCISCO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2011
Last Update Date: 11/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 PARNASSUS AVE MUW 405 BOX 0118
SAN FRANCISCO CA
94143-0118
US

IV. Provider business mailing address

500 PARNASSUS AVE MUW 405 BOX 0118
SAN FRANCISCO CA
94143-0118
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-8195
  • Fax: 415-353-4716
Mailing address:
  • Phone: 415-353-8195
  • Fax: 415-353-4716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number
License Number State

VIII. Authorized Official

Name: SONYA FULLER
Title or Position: CAREER CREDENTIALING
Credential:
Phone: 415-353-9221